<!--
  ========================LICENSE_START=================================
  screenit-web
  %%
  Copyright (C) 2012 - 2020 Facilitaire Samenwerking Bevolkingsonderzoek
  %%
  This program is free software: you can redistribute it and/or modify
  it under the terms of the GNU Affero General Public License as published by
  the Free Software Foundation, either version 3 of the License, or
  (at your option) any later version.
  
  This program is distributed in the hope that it will be useful,
  but WITHOUT ANY WARRANTY; without even the implied warranty of
  MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  GNU General Public License for more details.
  
  You should have received a copy of the GNU Affero General Public License
  along with this program.  If not, see <http://www.gnu.org/licenses/>.
  =========================LICENSE_END==================================
  -->
<html xmlns:wicket="http://wicket.apache.org">
<wicket:panel>
    <form wicket:id="uploadForm">

        <fieldset class="form-horizontal">
            <h2 class="form-titel">hrHPV informatie</h2>
            <div class="row-fluid">
                <div class="span6">
                    <div class="control-group value">
                        <label class="control-label">Message id</label>
                        <div class="controls"
                             wicket:id="beoordeling.hpvBericht.messageId">
                            23-10-2012
                        </div>
                    </div>
                    <div class="control-group value">
                        <label class="control-label">Monster-id</label>
                        <div class="controls" wicket:id="uitnodiging.monster.monsterId"></div>
                    </div>
                    <div class="control-group value">
                        <label class="control-label">Laboratorium</label>
                        <div class="controls" wicket:id="uitnodiging.monster.laatsteHpvBeoordeling.hpvBericht.laboratorium.naam">FIT laboratorium Deventer</div>
                    </div>
                    <div class="control-group value">
                        <label class="control-label">Instrument id</label>
                        <div class="controls" wicket:id="beoordeling.hpvBericht.instrumentId">FIT laboratorium Deventer</div>
                    </div>
                </div>
                <div class="span6">
                    <div class="control-group value">
                        <label class="control-label">Uitslag</label>
                        <div class="controls" wicket:id="beoordeling.hpvUitslag.naam">100</div>
                    </div>
                    <div class="control-group value">
                        <label class="control-label">Analysedatum</label>
                        <div class="controls"
                             wicket:id="beoordeling.analyseDatum">
                            16-10-2012
                        </div>
                    </div>
                    <div class="control-group value">
                        <label class="control-label">Autorisatiedatum</label>
                        <div class="controls"
                             wicket:id="beoordeling.autorisatieDatum">
                            23-10-2012
                        </div>
                    </div>
                </div>

                <div class="row-fluid">
                    <wicket:enclosure child="fileUpload">
                        <div class="span6 pull-right">
                            <div class="control-group value">
                                <label class="control-label" for="fileUpload"> Brief upload </label>
                            </div>
                            <div class="control-group value">
                                <input type="file" wicket:id="fileUpload" id="fileUpload"/>
                                <button type="button" class="btn right upload" title="Uploaden" name="doorgaan" wicket:id="uploadSubmitBtn">
                                    <i class="icon-upload"></i>
                                </button>
                            </div>
                        </div>
                    </wicket:enclosure>

                </div>
            </div>
        </fieldset>
    </form>
    <div wicket:id="confirmDialog"></div>
</wicket:panel>
</html>
